New Drugs and Therapies
The ADA Scientific Sessions have always been a nexus for the release of new data for emerging new drug and therapies, and this year there were some particularly interesting findings reported. Incretins, and in particular long-acting GLP-1 analogs like Novo Nordisk's liraglutide, were a hot topic, along with SGLT2 inhibitors, 11-HSD-1 inhibitors, IL-1 blockers and inhalable insulin. We'll explain what each of these is below. Of note, these classes totally eclipsed DPP-4 inhibitors, the drug class of Merck's Januvia (sitagliptin). Research on DPP-4 inhibitors were out in force in the poster hall, but received little attention from speakers.
- Perhaps the most hotly anticipated results were from the LEAD-6 study, which compared Novo Nordisk's Victoza (liraglutide) with Amylin's Byetta (exenatide) over the course of 26 weeks. Incretin mimetics act like a natural body hormone called GLP-1, which helps to stimulate insulin release when blood sugar levels are high. From a baseline A1c of 8.2% in both groups, there was a 1.12% decrease in the liraglutide group and a 0.79% decrease in the exenatide group. Nausea rates were also significantly less in the liraglutide group, with 2% reporting nausea compared to 10% with exenatide.
- There were several talks on SGLT2 inhibitors, including BristolMeyerSquibb and AstraZenica's dapagliflozin, Johnson & Johnson's canagliflozin and Isis' ISIS 388626. This drug class acts by allowing the kidneys to secrete glucose in the urine, thereby lowering levels in the blood. Results of these new drugs were promising, with minimal side effects (the most common of which being urinary tract infections).
- Although there were few talks specifically on the subject, 11-HSD1 inhibitors had a few posters showing incremental research progress. This class inhibits a liver enzyme that activates cortisol, a steroid hormone that raises blood sugar. Although there is limited data available in this class, it's novel mechanism of action makes a promising potential therapy.
- A company called Xoma is developing a new drug that blocks IL-1, a signalling molecule in the body that leads to inflammation and is elevated in people with type 2 diabetes. Blocking this molecule appears to improve insulin sensitivity. The caveat, however, is that, since it modulates the immune system, the drug must be studied extensively to detect any adverse effects.
- Finally, there was some positive data presented for Mannkind's Afresa, an inhalable insulin. There have been no reports of increased rates of cancer or lung damage, and a new study has shown that Afresa is just as effective as Novolog at lowering A1c. This is an enormous boon to inhalable insulin, but it remains to be seen if Mannkind can shed the stigma left by Exubera.
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A few years ago, I wrote about a friend whose struggles with Disability left him without insulin for weeks at a time. Today, I ask those of you who follow the tradition to light a blue candle for "Tiny", who passed from this world yesterday morning. From what I know, this young man (he was no older than 37, and may not have even reached the age of 30) had early onset type 2...